A meta-analysis on surgical treatments for chronic pancreatitis: duodenum-preserving pancreatic head resection versus pylorus-preserving pancreaticoduodenectomy / 中华肝胆外科杂志

Objective To compare the safety and effectiveness of duodenum-preserving pancreatic head resection (DPPHR) with pylorus-preserving pancreaticoduodenectomy (PPPD) in the treatment of chronic pancreatitis with a pancreatic head mass.Methods Medline,Biosis,Cochrane Library,Science Citation Index Database,CBM Database,Wan Fang and CNKI were searched systematically.The bias risk of the included trials was assessed according to the assessing tools as suggested by the Cochrane Handbook.Review Manage 5.2 was used to perform the statistical analysis.Results 7 RCTs with 226 patients were included in the meta-analysis which showed that there were no significant differences between PPPD and DPPHR in overall postoperative morbidity,postoperative hospital stay,complete pain relief,pancreatic fistula,exocrine insufficiency,symptom score at 5 to 7-year follow-up,and quality of life score at 14 to 15-year follow-up (P ＞ 0.05).While DPPHR had significant superiorities in operation time,blood replacement,delayed gastric emptying,occupational rehabilitation after the operations,weight gain,quality of life score at 1 to 2-year follow-up,symptom score at 5 to 7-year follow-up,and physical functioning score at 14 to 15-year follow-up.Conclusions DPPHR is more favourable than PPPD in reducing the use of blood replacement,shortening operation time,delayed gastric emptying,occupational rehabilitation after the operations,weight gain,physical functioning,and in improving quality of life of patients.

Endoscopic Management of Afferent Loop Syndrome after a Pylorus Preserving Pancreatoduodenecotomy Presenting with Obstructive Jaundice and Ascending Cholangitis

Afferent loop syndrome is a rare complication of gastrojejunostomy. Patients usually present with abdominal distention and bilious avomiting. Afferent loop syndrome in patients who have undergone a pylorus preserving pancreaticoduodenectomy can present with ascending cholangitis. This condition is related to a large volume of reflux through the biliary-enteric anastomosis and static materials with bacterial overgrowth in the afferent loop. Patients with afferent loop syndrome after pylorus preserving pancreaticoduodenectomy frequently cannot be confirmed as surgical candidates due to poor medical condition. In that situation, a non-surgical palliation should be considered. Herein, we report two patients with afferent loop syndrome presenting with obstructive jaundice and ascending cholangitis. The patients suffered from the recurrence of pancreatic cancer after pylorus preserving pancreaticoduodenectomy. The diagnosis of afferent loop syndrome was confirmed, and the patients were successfully treated by inserting an endoscopic metal stent using a colonoscopic endoscope.

Endoscopic Management of Afferent Loop Syndrome after a Pylorus Preserving Pancreatoduodenecotomy Presenting with Obstructive Jaundice and Ascending Cholangitis

Afferent loop syndrome is a rare complication of gastrojejunostomy. Patients usually present with abdominal distention and bilious avomiting. Afferent loop syndrome in patients who have undergone a pylorus preserving pancreaticoduodenectomy can present with ascending cholangitis. This condition is related to a large volume of reflux through the biliary-enteric anastomosis and static materials with bacterial overgrowth in the afferent loop. Patients with afferent loop syndrome after pylorus preserving pancreaticoduodenectomy frequently cannot be confirmed as surgical candidates due to poor medical condition. In that situation, a non-surgical palliation should be considered. Herein, we report two patients with afferent loop syndrome presenting with obstructive jaundice and ascending cholangitis. The patients suffered from the recurrence of pancreatic cancer after pylorus preserving pancreaticoduodenectomy. The diagnosis of afferent loop syndrome was confirmed, and the patients were successfully treated by inserting an endoscopic metal stent using a colonoscopic endoscope.

Treatment Experience of Solid Pseudopapillary Tumor of the Pancreas in Children

Solid pseudopapillary tumor (SPT) of the pancreas occurs most frequently in the second or third decades of life, and is prevalent in females. Unlike other pancreatic malignancy, SPT usually has a low malignancy potential. This study reviews our clinical experience and surgical treatment of pancreatic SPT. Admission records and follow-up data were analyzed retrospectively for the period between January 1996 and January 2003. Five patients with a pancreatic mass were operated upon and SPT was confirmed by pathology in each case. The male to female ratio was 1 : 4. The median age was 13.8 years. Findings were vague upper abdominal pain (n=5, 100 %) and an abdominal palpable mass (n=3, 60 %). The median tumor diameter was 6.8cm and the locations were 2 in the pancreatic head (40 %) and 3 in the pancreatic tail (60 %). Extra-pancreatic invasion or distant metastasis was not found at the initial operation in all five cases. A pyloruspreserving pancreaticoduodenectomy (n=1) and a mass enucleation (n=1) were performed in two patients of pancreatic head tumors. For three cases of tumors in pancreatic tail, distal pancreatectomy (n=2) and combined distal pancreatectomy and splenectomy (n=1) were performed. The median follow-up period was 60 months(12-117month). During the follow-up period, there was no local recurrence, nor distant metastasis. Postoperative adjuvant chemotherapy or radiotherapy was not carried out. All five children were alive during the follow up period without any evidence of disease relapse. SPT of the pancreas in childhood has good prognosis and surgical resection of the tumor is usually curative.

Comparison of Clinical Outcomes between Pylorus Preserving Pancreaticoduodenectomy and Pancreaticoduodenectomy / 한국간담췌외과학회지

PURPOSE: A pancreaticoduodenectomy (PD) and pylorus-preserving pancreaticoduodenectomy (PPPD) are the two methods commonly used to treat periampullary neoplasms. This study was designed to compare these two methods in terms of the post-operative complications, the recurrence rate, and the post-operative weight change. METHODS: The medical records of 110 patients who underwent PD or PPPD from February 1986 through to June 2002 were retrospectively reviewed. The PD was performed on 54 patients and PPPD was performed on 56 patients, respectively. The mean follow-up periods were 25.33 months in the PD group and 25.39 months in the PPPD group, respectively. RESULTS: Diabetes mellitus occurred in 9 patients (16.7%) in the PD group and 8 patients (14.3%) in the PPPD group, and gastric emptying was delayed in 14 (25.9%) and 15 (26.8%) patients of each group after surgery. Procedure related deaths occurred in 2 (3.7%) and 4 (7.1%) patients from each group. There were no statistically significant differences in the post-operative complications between the two groups. The disease recurrence rate was significantly lower in the PPPD group than in the PD group (60.5% vs. 22.9%, p=0.001). Post-operative weight loss just after surgery at 3 months and 6 months after surgery was 3.56 kg, 3.68 kg, and 3.97 kg in the PD group and 2.78 kg, 1.77 kg, and 1.8 kg in the PPPD group, respectively, without showing a statistically significant difference. CONCLUSION: The clinical outcomes of the PPPD was not different from those of the PD in terms of the post-operative complications and weight loss. The disease recurrence rate was lower in the PPPD group. These results suggest that PPPD could be the treatment choice periampullary neoplasms.

Changes of the Gastric Motility after Pylorus Preserving Pancreaticoduodenectomy

BACKGROUND: To evaluate delayed gastric emptying after a pylorus-preserving pancreaticoduodenectomy, we studied gastric motility in 11 normal volunteers and 11 patients who had undergone a pylorus-preserving pancreaticoduodenectomy. Additionally, the 24 hour esophageal Ph recordings were examined to evaluate gastroesophageal reflux after a pylorus-preserving pancreaticoduodenectomy. METHODS: Gastric motility was evaluated by using the gastric-emptying time and electrogastrograms. The gastric-emptying time was measured using a solid meal containing 99mTc-tin colloid. The half gastric-emptying time (GET1/2) was defined as the half time (T1/2) of the fall of gastric isotopic activity from the peak. Electrogastrogram (EGG) signals were detected from the surface electrodes on the skin overlying the gastric antrum. The 24-hour esophageal Ph was monitored by using a nasoesophageal probe placed in the distal esophagus 5 cm above the lower esophageal sphincter. RESULTS: In our study, the normal volunteers showed a 99+/-35 minute half gastric-emptying time. The patients were divided into two groups by a time of 2 months after the operation, early and late postoperative groups. Delayed gastric emptying after a pylorus-preserving pancreaticoduodenectomy in the early postoperative period (272+/-176 minutes) was normalized in the late period (106+/-37 minutes), p=0.020. Abnormal early EGG patterns also normalized in the late postoperative period. There was no significant difference of total Ph<4-time % between patients in the early (0.1+/-0.1%) and the late postoperative periods (0.4+/-0.4%), p=0.064. CONCLUSIONS: It is supposed that anatomical and functional preservation of the stomach and the proximal part of the duodenum after a pylorus-preserving pancreaticoduodenectomy enabled gastric motor activity to be normal in the late postoperative period.

Comparision between a Pylorus-Preserving and a Whipple Pancreaticoduodenectomy

The aim of this study was to establish whether the pylorus-preserving pancreatico-duodenectomy (PPPD) is a safe, but radical, procedure in the treatment of malignant periampullary lesions, without increased morbidity and mortality rates, compared with the standard Whipple's procedure (PD). From 1993 to 1996, a PD (N = 25) or a PPPD(N = 15) was performed on 40 patients. Postoperative mortality rates were 2% after the PD and 0% after the PPPD. The mean operation time and blood loss in the PPPD group were 465 minutes and 840ml, respectively, and in the PD group were 444 minutes and 1080ml, respectively, both statistically insignificant. During follow-up, no differences were found in the postoperative complications, the recurrence of disease, and survival rates according to operation type, lymph node metastasis, or pancreas invasion. No differences were found the numbers of days of gastric drainage, liquid diet, and regular diet, but a delayed gastric emptying time was found in the PPPD group(40% of the patients after PPPD vs 12% after PD). Tumor-containing duodenal or gastric resection margins were not found in either group of patients. The hospital stay was the same for both groups (38 days after PPPD, 37 days after PD). The mean duration of follow-up was 23 months. Weight gain fter operation during follow-up was relatively more favorable after a PPPD. In conclusion, a PPPD is a safe, but radical, procedure and can be an alternative choice, without compromising curability. to a PD in the treatment periampullary cancer. No difference in either the morbidity or the mortality rates existed between the two procedures. Further investigation will be needed to understand the delayed gastric emptying time in the PPPD group, but during 3 months, of follow-up weight gain was better in the PPPD group.